Provider Demographics
NPI:1033147111
Name:DOAN, LESA LACKEY (LCSW ACSW BCD RPTS)
Entity Type:Individual
Prefix:MS
First Name:LESA
Middle Name:LACKEY
Last Name:DOAN
Suffix:
Gender:F
Credentials:LCSW ACSW BCD RPTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11215 HERMITAGE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211
Mailing Address - Country:US
Mailing Address - Phone:501-221-2811
Mailing Address - Fax:501-221-2812
Practice Address - Street 1:11215 HERMITAGE
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211
Practice Address - Country:US
Practice Address - Phone:501-221-2811
Practice Address - Fax:501-221-2812
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC574104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR140706744Medicaid
AR5S205Medicare ID - Type Unspecified